Mortalidade e contexto do uso das formulações de anfotericina B em pacientes com histoplasmose disseminada e AIDS em hospital de referência

Abstract

Disseminated histoplasmosis (HD) is an AIDS-defining disease, with high mortality in underdeveloped countries, in which the delay in diagnosis and the consequent initiation of treatment, in addition to the unavailability of liposomal amphotericin B, directly impact a worse prognosis. The induction treatment of HD in patients with HIV / AIDS at the reference hospital for infectious diseases in Ceará is routinely performed with amphotericin B deoxycholate, reserving lipid formulations for cases with renal failure at hospital admission or during hospitalization. The aim of this work was to evaluate the effectiveness, tolerability, complications and context of use of the different formulations of amphotericin B for the treatment of HD induction in AIDS patients. This was a retrospective study carried out through consultation of medical records of patients with HIV / AIDS and confirmed HD, treated in the induction phase with amphotericin B at Hospital São José, from January 2014 to December 2015. Forty six patients were included in the study, of these , 25 used amphotericin deoxycholate (group 1) to treat HD, 13 used amphotericin B deoxycholate then switched to liposomal amphotericin B or lipid complex (group 2) and eight used only liposomal amphotericin or lipid complex (group 3). The mean age in group 1 was 39.2 years (SD = 10.8; 25-63 years), group 2 was 35.6 years (SD = 4.74; 27-50 years) and in group 3: 36.6 years (SD = 9.2; 37 - 39 years). On admission, serum creatinine levels were higher in group 3; all patients had a low mean albumin value, especially in group 2. Vomiting, hepatomegaly, hemoglobin <8g / dl at the outcome (discharge or death), creatinine> 1.5mg / dl during hospitalization and at the outcome had a significant association with use of lipid formulation. The overall mortality during the study period was 32.6%. No reduction in mortality was observed with the use of lipid formulations. In conclusion, the most severe patients were in the group that used lipid preparations and most likely this contributed to the highest mortality observed among them. This study points out the need to change the criteria for the use of lipid formulations in order to have a favorable impact on the patients outcome with this severe fungal pathology.